Medical abortion (MA)
Medical abortion is the use of mifepristone and misoprostol pills, or misoprostol pills alone, to induce an abortion. This method can be used up to 24 weeks of pregnancy, but different doses and regimens apply, depending on the duration of pregnancy.
Some of the advantages of medical abortion are that it avoids a surgical procedure. It is like having a spontaneous miscarriage, the pills are used by the woman and the abortion can safely take place at home through 10 weeks of pregnancy. After that, it is safer to use this method in a clinical setting, especially in the second trimester of pregnancy.
The disadvantage of medical abortion is that it takes from several hours to several days for the abortion to be complete. Most of the bleeding with medical abortion is within the first 1-2 days, but it may continue for some days or even a couple weeks after that. The misoprostol causes cramping as it makes the uterus contract, and it can also cause nausea and vomiting.
The combination of mifepristone + misoprostol in the right doses causes a complete abortion in 96-98% of cases. Mifepristone is only available in about 60 countries, however, misoprostol is available in almost all countries because it has other medical uses in addition to abortion. Misoprostol alone is not as effective as the combination of mifepristone + misoprostol, so women may need to take a repeat dose several times to achieve a complete abortion. Most women seem to know when the abortion is complete, or within a few days that they are still pregnant.
Vacuum aspiration (VA)
Vacuum aspiration (VA) involves evacuation of the contents of the uterus, either manually by the use of a hand-held plastic aspirator (MVA) or with an electric vacuum pump (EVA). This can also be done with an electric vacuum pump (EVA). This method has a success rate of 95-100% up to 14 weeks of pregnancy. Depending on the duration of pregnancy, abortion with vacuum aspiration takes from 3 to 10 minutes to complete, and can be performed at primary level on an outpatient basis using a local anaesthetic. Most women feel well enough to go home after 30 minutes.
The advantage of vacuum aspiration abortion (a simple surgical method) is that it only takes a few minutes. In addition, most of the blood, fluids and tissue, that must come out naturally with medical abortion, are collected with an aspirator during vacuum aspiration.
Dilatation and evacuation (D&E)
Dilatation and evacuation (D&E) requires a skilled, experienced provider. It is used in the second trimester usually after 14 weeks of pregnancy. A D&E procedure can usually be performed on an outpatient basis. General anaesthetic is not required and can increase risk. A D&E procedure usually takes no more than 30 minutes to perform.